Ob-Gyn Coders, Beware This Costly Modifier 24 Myth

E/M coding for doctor counseling patient

Suppose a Medicare patient presents to your ob-gyn practice for a visit scheduled as a follow-up after cervical lesion biopsy, but the doctor also spends time on counseling and coordination of care related to the malignant tumor the biopsy identified. Can you report an E/M with modifier 24 if the visit is during the biopsy’s global period? Below you’ll find helpful hints from TCI’s Ob-Gyn Coding Alert.

Don’t Get Too Hung Up on What the Schedule Says

It is a myth that you can’t report an E/M code for a visit just because the schedule says it is a follow-up visit during the global. True, you can’t report the services for the routine care for the cervical biopsy. But if documentation supports reporting a separate E/M for the time spent on counseling and coordination of care for the malignant tumor, you shouldn’t let the phrase “follow-up visit” used in the schedule prevent you from coding that distinct E/M.

For proper reporting, do not include the time used on routine follow-up care when you tally the time for the E/M code level. And then be sure to append modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to the E/M code. To support use of modifier 24, documentation must support “that the service is not related to the post-operative care of the procedure,” according to Medicare’s Global Surgery Booklet.

Remember: Medicare does not consider “treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery” to be part of the global surgical package, states the Medicare Claims Processing Manual, Chapter 12, Section 40.1.B. So you can feel confident reporting an E/M or other appropriate code for these services during the global period.

Improve Your Coding With More Mod 24 Advice

Your payer may offer more specific guidance to help you understand proper use of this modifier. For instance, here are some additional modifier 24 pointers from WPS Government Health Administrators, the Part B Medicare Administrative Contractor (MAC) for Jurisdiction 5 and Jurisdiction 8:

  • You should append modifier 24 to only E/M codes.
  • Examples of appropriate use of modifier 24 include reporting an E/M for managing immunosuppressant therapy after a transplant or managing chemotherapy after a procedure.
  • Examples of inappropriate use of modifier 24 include use on the same day as a procedure or for admission of a patient to a skilled nursing facility for a condition related to the surgery.

Final pointer: The descriptor for modifier 24 states the service is “by the same physician or other qualified health care professional.” WPS advises you to keep in mind that, for Medicare purposes, “Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.”

What About You?

What are your tips for making sure you use modifier 24 correctly? Are there codes you append this modifier to frequently?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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